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Y4k4 TOWNM U
IIEPTET 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
May 3, 2019 PAYABLE UPON RECEIPT
(X) Fee Required 134.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a
Certificate of Inspection for the below-named premises located at the following address:
Street and Number: /2 CI Rolm- 02E
Name of Premises: 6 (_ f 1149 Tel: 50,S ` 3qe 02 if
Purpose for which permit is used: / ' 0'let
License(s) or Permit(s)required for the premises by other governmental agencies:
License or Permit %v , l Agency
,t,
f-9 0(9 d <On s 20 B 0 N ,
Certificate to be issued to sy" �! _�y 1�►"� � 3 �.6 �3 lI
Address: / C( ' P` C®ce ? r, 1 -en02 69
Owner of Record of Building 7
Address
Present Holder •f Cer ' : - ____._
fita
Ail �Au4.
Sig Ire Torf perso r to whom Title
Certi icate is issue or his agent * e2 aete,
Date -'
Email Address: CC te42-6 ''�,,
Instructions: Make check payable to: Town of Yarmouth
1146 Route 28, South Yarmouth, MA 02664
Return this application to: Building Inspector's Office
Please note: Application form with accompanying fee must be submitted for each building or structure or part thereof
to be certified. Application must be received before the certificate will be issued. The building official shall be
notified within ten(10) days of any change in the above information.
PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS
APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION.
Certificate of Inspection# -1—/6- 00 6 7 f 9`C.
6/8/2019-6/8/2020
UILDING
�...o° yqR __ TOWN OF YARMOUTH BE
,:F� . O GAS
y�;, i 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING
_,
'Ilk Telephone (508) 398-2231, Ext.1261 —Fax (508)398-0836
_, mATTaeHEESE SIGNS
,,.'' BUILDING DEPARTMENT
Inspection and License Report j5P
"g``� Or'
-
Address % /�// . C"� 4 %"`� Business Name Cam//l/t !��'y f�l G"!/j
�
/'Contact Phone ci ,. . /I
During the Annual Inspection of your premises,performed in accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts
State Building Code),the Board of Selectmen,and/or the Board of Health rules,the following violation(s)were observed:
Egress 4
❑ Emergency egress signage Location
Emergency egress lighting Location
Li Maintenance of exits Location
Di Guards/handrails Location ,,,i/ly
Zoning
El Signs Location
Cji Parking Location
ID Other Location
Mechanical
Cli Combustion Air Location
Storage in Boiler Room Location
L]Vents Location
❑Automatic door closures `
on boiler room doors Location
ID Clothes dryer vents Location
Other Location
The State Building Code,Section 1001.3-Maintenance,provides that the owner as defined in Section 780 CMR shall be
responsible for proper maintenance.
In order to abate the above violation(s)you must:`
1
o Make corrections immediately and contact this office for a follow-up inspection. •
o Make corrections prior to opening and contact this office for a follow-up inspection.
o Make corrections prior to your next annual inspection.
o Make corrections within days and contact this office for a follow-up inspection.
Local Oficial/Inspeaor 0 i/
Received By Title
Revised 2/8/13